Tips for recognizing, living with and preventing atrial fibrillation (AFib)

Atrial fibrillation, or AFib, is a fast and irregular heart rhythm that, left untreated, can lead to blood clots, stroke and heart failure. It's the most common type of arrhythmia, a potentially serious condition in which the heart beats too quickly, too slowly or in an irregular pattern.

RUSH electrophysiologist Erica Engelstein, MD, who specializes in treating heart rhythm disorders, shares five facts about AFib—including tips to prevent or help manage this condition that affects at least 2.7 million Americans.

1. You can have AFib and not even feel any symptoms

"The symptoms of AFib can feel scary and debilitating, or only mild," Engelstein says. These symptoms can include:

• Palpitations
• Rumbling or galloping feeling in the chest
• Lightheadedness
• Shortness of breath
• Extreme fatigue
• Chest pain

But some AFib episodes cause no symptoms at all.

"About half the patients do not feel these initial symptoms but develop other symptoms within days or weeks, such as feeling tired, short of breath with exertion, lack of energy or swelling of their feet. These delayed symptoms are related to congestive heart failure as a result of the abnormal heart rate and rhythm. A small subset of patients does not develop any symptoms at all even years after being in atrial fibrillation," Engelstein says.

That's why it's so important to have regular visits with your primary care provider—and to see a specialist if you've been diagnosed.

2. AFib causes up to one in four strokes, and they're more severe

AFib is the culprit in a staggering number of strokes. That's because it can cause blood to pool in the heart's upper chambers and form clots—which may travel to the brain, block the flow of blood and lead to a stroke.

"People with AFib are overall five times more likely to have a stroke, though the individual risk can range anywhere from less than one percent to 20 percent depending on the presence of certain additional risk factors," Engelstein says. The risk of AFib-related stroke also increases with age.

"Strokes due to AFib tend to be more severe with more damage to the brain and worse long-term effects," Engelstein says. "The vast majority of strokes related to AFib can be prevented with blood thinners or special procedures that plug the left atrial appendage where most strokes come from."

3. Lifestyle changes and medications can help you prevent AFib or manage risk factors

Some risk factors for AFib are out of your control, including age, gender or genetics. Age especially can increase risk even in the healthiest people.

"Thankfully, most risk factors for AFib can be controlled, either with medications or with lifestyle changes," Engelstein says.

AFib risk factors that you can manage with lifestyle changes and medication include obesity, sleep apnea, diabetes, hypertension, coronary artery disease, heart valve disease, thyroid disease, alcohol consumption and lack of exercise.

Here are a few tips to help manage your AFib risk factors:

• Exercise regularly. "As long as the heart rate is well controlled, patients with AFib should exercise at least for 30 minutes a day, five times a week," Engelstein says. "It is a good idea to monitor the heart rate during exercise in order to not exceed physiologic heart rates."
• Eat healthy and maintain a healthy weight. A diet designed for people with heart disease can be helpful for people with AFib. The American Heart Association suggests focusing your diet on fruits and vegetables and including foods that are low in sodium.
• Monitor your alcohol intake. "There is probably no safe amount of alcohol when it comes to AFib; though, some people are more sensitive than others," Engelstein says. "In a large study, it has been shown that consumption of even one glass of alcohol a day increases your risk of developing AFib by 16 percent."
• Manage other health conditions. Talk to your doctor about medications and other treatments for risk factors such as sleep apnea, high blood pressure and diabetes among others.
• Quit smoking. Smoking has toxic effects on all aspects of the heart including the rhythm. Talk to your doctor about ways to quit smoking.
• Manage stress levels. "Although stress does not directly cause AFib, it can influence conditions such as blood pressure and diabetes, which in turn can increase your risk," Engelstein says. "On the other hand, it has been shown that yoga, meditation and other means of stress reduction can decrease the risk of recurrence in patients who go in and out of AFib."

4. Treatment options have come a long way, and they keep getting better

"Treatment of atrial fibrillation has been rapidly evolving over the past two decades," Engelstein says. "The most effective treatment is catheter ablation, a same-day, minimally invasive procedure that treats the source of AFib in the left upper chamber of the heart."

In the best outcomes, ablation can reduce a person's time in AFib by more than 98%.

"Newer catheters, energy sources and imaging techniques have made this procedure safer and more effective. If this treatment can be performed in a timely manner, it can halt progression of the heart disease related to AFib."

Medications such as blood thinners (to prevent strokes) have also become more effective and manageable, no longer requiring dietary restrictions or frequent monitoring and dose adjustments. "Specific antiarrhythmic medications continue to be used as additional therapy for AFib and to control the heart rate," Engelstein says.

But some people with AFib may be unable to take blood thinners, particularly those who have a history of internal bleeding or frequent falls. An alternative is the WATCHMAN implant, a minimally invasive, one-time procedure to close off the left atrial appendage—a small pouch connected to the upper left chamber of the heart where clots form.

Treatments continue to improve, and many patients who experience AFib can manage the condition to the point where they are able to fully live their lives with very few limitations or restrictions.

"Equally important in preventing progression of AFib is managing risk factors if they are present," Engelstein says.

5. Your smartwatch or device may help you detect AFib

If you have an Apple Watch, a Fitbit, or another device that monitors your heart rate, it may help you detect an abnormal heart rhythm. While it cannot diagnose your AFib, detecting an arrhythmia can be the first sign that you need to see a doctor.

"Smartwatches that reliably detect atrial fibrillation are a game changer in managing patients with AFib," Engelstein says. "They are important in the initial diagnosis in patients who do not have symptoms. They are also important in the long-term follow-up of patients to detect recurrences and assess treatment effect."

If you use a wearable device that can monitor your heart rate, make sure to look for any abnormalities and report them to your doctor.